Shrivastava Tanvi, Khan Mubarak Muhamed, Parab Sapna Ramkrishna
Department of ENT, Nalanda Medical College, Patna, India.
Consultant Sushrut ENT Hospital and Dr. Khan's ENT Research Center, Talegaon Dabhade, India.
Indian J Otolaryngol Head Neck Surg. 2022 Aug;74(Suppl 1):550-558. doi: 10.1007/s12070-021-02388-0. Epub 2021 Jan 21.
The study puts forth the learning curve of two handed endoscopic middle ear dissection on a sheep temporal bone. It also highlights the usage of sheep temporal bone as an effective simulation technique for two-handed cadaveric temporal bone dissection. 6 sheep temporal bone models were dissected in a period of 15 days. Harvesting of cartilage graft, endoscopic myringotomy and grommet insertion, cartilage butterfly tympanoplasty, ossiculoplasty, stapes surgery and facial nerve decompression, using the Endohold®, were conducted on each bone. There was a remarkable decrease in the time required for subsequent temporal bone dissections, with significant improvement in efficiency, accuracy and neatness of dissection. Practice and experience resulted in upliftment in the level of confidence of the fellow. Striking similarities were noticed between sheep and human temporal bones. Availability of both the hands with a clear endoscopic view made it easier and more convenient to perform various procedures. Two handed endoscopic technique provides an excellent approach for ear surgeries. Availability of both the hands for the delicate surgery along with the spectacular endoscopic view contributes to increase in efficiency and surgery outcome. Cadaveric dissection of sheep temporal bones provides a great learning experience for a trainee to practice these delicate and skilful two-handed endoscopic middle ear surgical exercises. Its easy availability and striking similarity of the anatomy makes it a boon for the beginners. It gives ample opportunity to the trainee to explore and learn the complex anatomy, try new skills and develop an expertise in this field. The efficiency and accuracy increases significantly with each dissection, smoothening out the steep learning curve, that is, for such fine and intricate surgical skills.
该研究提出了在绵羊颞骨上进行双手内镜中耳解剖的学习曲线。它还强调了绵羊颞骨作为双手尸体颞骨解剖有效模拟技术的用途。在15天内对6个绵羊颞骨模型进行了解剖。在每块骨上使用Endohold®进行软骨移植采集、内镜鼓膜切开术和鼓膜置管、软骨蝴蝶鼓膜成形术、听骨成形术、镫骨手术和面神经减压。后续颞骨解剖所需时间显著减少，解剖效率、准确性和整洁度有显著提高。实践和经验提升了学员的信心水平。绵羊和人类颞骨之间存在显著相似性。双手可用且内镜视野清晰，使得进行各种手术更加容易和方便。双手内镜技术为耳部手术提供了一种极佳的方法。双手可用于精细手术以及壮观的内镜视野有助于提高效率和手术效果。对绵羊颞骨进行尸体解剖为学员提供了很好的学习体验，使其能够练习这些精细且需要技巧的双手内镜中耳外科手术操作。其易于获取以及解剖结构的显著相似性对初学者来说是一大福音。它为学员提供了充足的机会来探索和学习复杂的解剖结构，尝试新技能并在该领域发展专业知识。每次解剖后效率和准确性都会显著提高，从而平缓了陡峭的学习曲线，也就是说，对于如此精细复杂的外科技能而言。
